Professional Documents
Culture Documents
Childhood vaccinations 5 5 10
Adult tobacco cessation counseling * 5 4 9
Vision screening > 65 yrs * 4 5 9
Pap test, sexually active > 18 yrs 5 3 8
Colorectal cancer screening > 50 yrs * 5 3 8
Newborn metabolic screen 3 5 8
Hypertension screening 5 3 8
Influenza vaccine > 65 yrs 4 4 8
Lipid screening; men 35-65; women 5 2 7
45-65
Pneumovax >65 yrs * 2 5 7
Priorities among recommended clinical
preventive services
Pignone M, Levin B. Recent Developments in Colorectal Cancer Screening and Prevention. American Family
Physician 2002:297-302.
Screening Capacity
• ABSOLUTE
– Acute, severe cardiopulmonary disease.
– Inadequate bowel prep.
– Active diverticulitis
– Acute abdomen.
– History of SBE or prosthetic valves with no
prophylaxis.
– Marked bleeding dyscrasia.
Contraindications
• RELATIVE
– Recent abdominal surgery (bowel or
pelvic).
– Active infection
– Pregnancy.
Equipment
Additional Equipment
• Light source
• Suction apparatus
• Biopsy forceps
• K-Y Jelly
• 4X4 inch gauze pads
• Nonsterile gloves
• Water container (for suction)
More equipment
FIGURE 2.Paradoxic
insertion. (A) The scope is
bowing out the sigmoid
colon, which has a mobile
mesenteric attachment. (B)
Paradoxic insertion
describes the insertion of
the tube without
advancement of the scope
tip. Paradoxic insertion can
be very uncomfortable for
the patient.
Descending Colon
• Also triangular
• Advance to cecum by pulling back,
using suction, often releasing right lower
quadrant abdominal pressure
• Identify landmarks
– Ileocecal valve
– Appendiceal Orifice
– Terminal Ileum
Pedunculated Polyp
Diverticulosis
Crohn’s Colitis
C. Difficile Colitis
The Final Step-
Retroflexion
• Accomplished by turning inner knob all
the way “up” and outer knob all the way
“right” while gently inserting and rotating
180 degrees.
• Make sure you are in rectum, and not to
far from internal sphincter.
Retroflexion with
Hemorrhoid and Small
Polyp
What if Polyps are Found?
Be nice to your patient